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General NPI Number Information
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NPI Number | 1073735700
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Entity Type | Individual
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Provider Name | HADI KOESNODIHARDJO
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 855 JEFFERSON AVE UNIT 70
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City | REDWOOD CITY
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State | CA
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Zip | 94064-7200
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Country | US
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Telephone | 415-968-9540
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Fax | 650-550-9189
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | REDWOOD CITY
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State | CA
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Zip | 94064-0070
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Country | US
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Telephone | 415-968-9540
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Fax | 650-550-9189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC50900
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License Number State | CA
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